The use of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) in postoperative rehabilitation after lumbar microdiskectomy was compared with a standard exercise program in a major metropolitan hospital in Seoul, South Korea. A total of 33 patients aged 25 to 65 years were randomly assigned to the OMTh group (n=16) or exercise group (n=17).

Inclusion criteria were low back pain with referred leg pain caused by imagery-verified herniated intervertebral disk at spinal levels L3-4, L4-5, and L5-S1. Eight patients had more than 1 herniated disk. There were no statistically significant differences between the groups.

Primary outcome measures were the Roland-Morris Disability Questionnaire and visual analog scale (VAS) for pain. Secondary outcome measures were lumbar range of motion, use of medications, and patient satisfaction. Patients received either OMTh or exercise twice a week for 4 weeks, and each session was 30 minutes.

Each OMTh intervention was performed by 2 osteopathy students under the supervision of a qualified osteopath. Techniques were individualized and included soft-tissue and joint mobilization, myofascial release, muscle energy, craniosacral release, and rib raising; no high-velocity, low-amplitude thrust was used. The same exercise protocol was used for all patients in the exercise group and included stretching for low back and abdominal muscles, isometric strengthening for back and hip extensors, and back stability exercises using a Pilates exercise apparatus.

Outcome measures were made at baseline (2-3 weeks after surgery) and after the final rehabilitation session (7-8 weeks after surgery). Results showed that both groups improved on primary outcome measures; however, postsurgical physical disability was more improved in the OMTh group (54% vs 26%, P<.05). Although not statistically significant, residual leg pain on VAS was reduced 53% in the OMTh group and 17% in the exercise group, and residual back pain reduced 37% in the OMTh group and 10% in the exercise group. Patients in both groups required less frequent use of medications—reduced 87% in the OMTh group and 73% in the exercise group. Both groups were highly satisfied by their rehabilitation, and there were no adverse events reported for either group.

This study is the first to my knowledge that assessed the use of osteopathic manipulation after lumbar surgical care. I believe postsurgical use of osteopathic manipulative treatment would be beneficial for patients, and I hope this study is replicated in the United States soon.